What he actually says about your prescription
Before any of the biochemistry, he puts a fence around the whole episode, and it matters for a woman over 60 who is already on one.
Dr. Martin, The Doctor Is In, Episode 1252I am not your doctor. I'm an educator. I'm not in practice anymore, so that's important to understand that I'm an educator and we do this for educational purposes. So if you're on a statin drug, I will tell you what to do to minimize your side effects.
So the honest answer to should a woman over 60 take a statin is that he does not answer it for you, and he is deliberate about that. What he gives you is the case, and two practical things to do if you stay on it. The decision, and any change to a prescription, sits with you and your doctor.
Statins work, and that is not the argument
He gives the medication its due, which is easy to miss if you only ever hear him summarised.
Dr. Martin, The Doctor Is In, Episode 1252Now, back to the statin drugs. What did they do? Well, they worked. Statin drugs work. Okay? They work, they lower LDL Cholesterol.
His problem is one step upstream. He does not think LDL was ever the villain, so a medication that lowers it very effectively is, to him, solving a problem that was not the problem. He puts it in a picture.
Dr. Martin, The Doctor Is In, Episode 1252Blaming cholesterol for heart disease is like blaming the police. Of course, cholesterol is on the scene, but that doesn't make it a bad guy.
Cholesterol turns up where there is repair to do, is his reading, the way firemen turn up at a fire. And the thing he says caused the damage in the first place is inflammation driven by insulin. More on how the blame landed on cholesterol in the whole cholesterol thing is a hoax.
"You can't live without cholesterol. You need cholesterol. Every cell in your body has cholesterol."
Dr. Martin, The Doctor Is In, Episode 1252The CoQ10 problem
This is the part of the episode that explains every side effect that follows, and it is worth five slow minutes.
Your body makes cholesterol down a pathway called the mevalonate pathway. Further along that same pathway, it makes CoQ10. A statin works by blocking a step near the top of it. Block the step and you get less cholesterol, which is the point, and less CoQ10, which is not.
CoQ10 is what your mitochondria, the battery packs in your cells, run on. He points out where you have the most of them. Your heart, which is a muscle and never stops. And your brain, which he calls headquarters and says takes about 25 per cent of everything you eat.
So a medication taken for the heart lowers the thing the heart muscle needs for energy. That is his objection, stated as biochemistry rather than as opinion.
The two black box warnings
A black box warning is the strongest warning a medication carries. He names two on statins.
Dr. Martin, The Doctor Is In, Episode 1252One, a high likelihood black box warning that you become a diabetic. Two, that you have trouble with your memory.
The first is the one he finds hardest to accept, and he says why in plain terms. Diabetes is one of the largest risk factors for heart attack and stroke there is. A medication given to protect the heart that raises the risk of becoming diabetic is, in his words, ironic.
The second lands on the same CoQ10 point. Your brain is nerve tissue, it is built with cholesterol, and it needs a great deal of energy. He is blunt about what he thinks happens when you lower all three inputs at once, and he connects it to what he has watched increase over his career in neurological illness. He is careful to say he is convinced of it rather than that it is settled.
The shoulders and the legs
The side effect he saw most in practice was muscular, and it rarely arrived labelled as a side effect.
Patients came in with pain in the shoulders, he says, and could hardly lift their arms above their head. Sore legs. They wanted to know if it was arthritis. He would ask whether they were on a statin drug, and they never understood what that had to do with a shoulder. For a woman over 60, that is the trap. Aching shoulders and heavy legs get filed under getting older, and nobody goes back to the pill bottle.
He is clear that this is what he saw in his own clinic. It is clinical experience, not a trial.
What he told patients who stayed on them
Here is the practical part of the episode, and both halves are things you can do without changing a prescription.
The first is ubiquinol. If a statin lowers your CoQ10, he says, then take CoQ10, and ubiquinol is the form your body can use directly. He does not treat that as optional for someone on the medication.
The second is a blood test.
Dr. Martin, The Doctor Is In, Episode 1252They should be checked every couple of months if you're on statin drugs, because it can be very damaging to your liver, okay? Very damaging to your liver.
He is talking about liver enzymes, and he splits the medications two ways when he explains why: some are fat soluble, which he associates with the memory and nerve effects, and some are water soluble, which he associates with the liver. Either way, the enzyme check is the one he wanted on the chart.
What he says prevents heart disease instead
Asked how you would actually lower your risk, he does not go near the lipid panel.
Dr. Martin, The Doctor Is In, Episode 1252Now, how do you want to prevent heart disease? Okay, just from another viewpoint, how do you prevent heart disease? Get your stinking sugars down, get your insulin down.
And the argument he keeps coming back to is the fifty year one.
Dr. Martin, The Doctor Is In, Episode 1252And guys, the overarching thing that I've always told people for the last several years, if lowering cholesterol, either by your diet or by medication, was the best thing for heart disease, we would've got rid of heart disease by now, except this is a fact. Heart disease and stroke are worse than ever.
Which lines he does read on your blood work is the subject of the triglyceride to HDL ratio after 60, and what the standard ranges mean for a woman your age is in what is a normal cholesterol level for a woman over 60.
Common questions
Does Dr. Martin tell people to stop taking a statin?
No. He opens the episode saying he is an educator and not your doctor, and that what he will give you is how to minimise side effects if you are on one. Any change to a prescription is a conversation with your own physician.
What are the black box warnings on statins?
The two he names are a raised likelihood of becoming diabetic, and trouble with memory. He calls the first one ironic, because being diabetic is itself one of the biggest risk factors for heart attack and stroke.
Why do statins cause muscle pain?
His explanation is CoQ10. The pathway a statin blocks to make less cholesterol is the same pathway that produces CoQ10, and your muscles, including your heart, run on it. In clinic he saw shoulders and legs that patients had put down to arthritis.
What should I take if I am on a statin?
Ubiquinol, the usable form of CoQ10, is the one he names, and he asks for liver enzymes to be checked every couple of months while you are on the medication. Talk to your own doctor before adding anything.
The one he named
Martin Clinic's Ubiquinol is CoQ10 in the form your body can use, which is what he asked patients on a statin to take.
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